Frontal QRS-T angle predicts cardiac syncope in the emergency department

Area of Science:

• Cardiology
• Emergency Medicine
• Electrocardiography

Background:

• Identifying cardiac causes of syncope in emergency departments (EDs) is challenging.
• Objective electrocardiographic markers are needed for early risk stratification.

Purpose of the Study:

• To assess the diagnostic accuracy of the frontal QRS-T angle (fQRST) in differentiating cardiac syncope from non-cardiac causes in ED patients.
• To evaluate fQRST as a potential marker for cardiac syncope.

Main Methods:

• Retrospective analysis of 278 patients with confirmed syncope.
• Comparison of clinical, laboratory, and electrocardiographic parameters.
• Receiver operating characteristic (ROC) analysis and logistic regression to identify predictors of cardiac syncope.

Main Results:

• Cardiac syncope occurred in 18.8% of patients.
• The fQRST angle was significantly higher in cardiac syncope (p < 0.001).
• fQRST showed high discriminative performance (AUC=0.737) with an optimal cutoff of 43.5°.
• fQRST ≥43.5°, troponin positivity, and atrial fibrillation were independent predictors of cardiac syncope.
• The combination of fQRST and troponin enhanced diagnostic performance.

Conclusions:

• The frontal QRS-T angle is a potential electrocardiographic marker for identifying cardiac syncope in the ED.
• Combining fQRST with troponin may aid early clinical assessment and risk stratification.
• Further validation in larger, prospective studies is warranted.